H.E.

STUDENT INITIATED DEFERRAL

PLEASE ONLY COMPLETE SECTION A AND SUBMIT TO YOUR SCHOOL/COLLEGE OFFICE

SECTION A (TO BE COMPLETED BY STUDENT)

STUDENT ID NO. 21456408
SURNAME Costache
FIRST NAME Mihai
COURSE CODE CONMED001
COURSE TITLE BA CONTENT MEDIA & PRODUCTION
COURSE START DATE Oct 2022
DEFERRAL DATE* Oct 2023
* PLEASE USE THE DATE A DEFERRAL IS BEING REQUESTED ON. DEFINITIVE DATE WILL BE DETERMINED BASED ON
INFORMATION AVAILABLE FROM SWIPE, SAM, BLACKBOARD AND OTHER RELEVANT DATA SOURCES.

PLEASE COMPLETE YOUR REASON FOR DEFERRAL: (PLEASE ONLY SELECT ONE REASON)

HEALTH REASONS X
FINANCIAL REASONS
OTHER PERSONAL REASON
UNAVOIDABLE ABSENCE FROM UWL E.G. REQUIREMENTS OF EMPLOYER
UNAVOIDABLE ABSENCE FROM DOMICILE E.G. EVICTION
MATERNITY LEAVE
OTHER (PLEASE SPECIFY BELOW)

PLEASE MEET WITH YOUR COURSE LEADER TO AGREE YOUR RETURN DATE AND HAVE YOUR FORM
SIGNED OFF BEFORE SUBMITTING TO YOUR SCHOOL/COLLEGE

EXPECTED AGREED RETURN DATE RETURNING COHORT CODE

COURSE LEADER’S NAME: Alexandra Ferguson (Deputy Programme Leader)

COURSE LEADER’S SIGNATURE: DATE:

SECTION B (TO BE COMPLETED BY COMPLIANCE)

IF THE STUDENT IS AN OVERSEAS (TIER 4 VISA) STUDENT PLEASE COMPLETE THE SECTION BELOW:
PLEASE SELECT ONE ACTIVITY TYPE LISTED 1-3 AND ONE REASON LISTED IN ALPHABETICAL ORDER
(DATA DEPARTMENT ARE NOT ABLE TO PROCESS THE FORM UNLESS THESE FIELDS ARE COMPLETED)

1. SPONSOR HAS STOPPED SPONSORING THE STUDENT (CIRCLE ONE)

SPONSORSHIP WITHDRAWN: STUDENT HAS NOT ENROLLED
STUDENT HAS WITHDRAWN FROM STUDIES POST ENROLMENT
SPONSOR HAS EXCLUDED OR WITHDRAWN THE STUDENT FROM THE COURSE
COURSE HAS BEEN WITHDRAWN BY THE SPONSOR
THE STUDENT HAS DEFERRED THEIR STUDIES
COURSE IS COMPLETED EARLIER THAN EXPECTED
STUDENT HAS MOVED TO ANOTHER SPONSOR

VERSION 1 – UPDATED 16TH MAY 2017

H.E. STUDENT INITIATED DEFERRAL

INFORMATION RECEIVED THAT THE APPLICATION HAS BEEN REFUSED

2. STUDENT IS DELAYED
STUDENT ENROLMENT IS DELAYED; NEW DATE PROVIDED

3. PREVIOUS NOTIFICATION WITHDRAWN

PREVIOUS NOTIFICATION WITHDRAWN

IF YOU HAVE TICKED ANY OF THE OPTIONS ABOVE PLEASE PROVIDE DETAILS BELOW:

COMPLIANCE OFFICER’S NAME:

COMPLIANCE OFFICER’S SIGNATURE: DATE:

SECTION C (TO BE COMPLETED BY STUDENT)

STUDENT DECLARATION
PLEASE COMPLETE THE BELOW BEFORE SUBMITTING THIS FORM TO YOUR SCHOOL/COLLEGE OFFICE

I HAVE FULLY UNDERSTOOD ALL THE IMPLICATIONS OF DEFERRING FROM MY STUDY (ACADEMIC,
FINANCIAL AND VISA) AND I HAVE DISCUSSED THIS WITH STUDENT SERVICES.

I UNDERSTAND THAT I MAY DEFER, WITH THE FOLLOWING CONSEQUENCES:

• THE RESULT OF ANY MODULE THAT I HAVE COMPLETED (EITHER PASS OR FAIL) WILL BE RETAINED
• THE RESULT FOR ANY MODULE THAT HAS NOT BEEN COMPLETED (E.G. THE STUDENT HAS SUBMITTED
TO ALL ELEMENTS OF ASSESSMENT, EXCEPT THE FINAL ELEMENT OF ASSESSMENT) WILL NOT BE
RETAINED
• I WILL RE-ENROL ON THE MODULE ON MY RETURN
• I WILL NOT BE CHARGED AGAIN FOR THE MODULE
• THE MODULE WILL NOT COUNT AS A RETAKE AND WILL NOT BE CAPPED

I ACKNOWLEDGE THAT I MUST RETURN ON THE EXPECTED AGREED RETURN DATE AND THAT IF I FAIL TO DO
SO, THE UNIVERSITY MAY NOT PERMIT ME TO RETURN (SUBJECT TO PLACEMENT CAPACITY AND
AVAILABILITY)

STUDENT’S NAME: Mihai Costache

STUDENT’S SIGNATURE:
DATE:

SCHOOL OFFICE/COLLEGE TO COMPLETE THE BELOW

DATE RECEIVED SCHOOL STAMP
DATE SENT TO DATA
NAME
ADMIN SIGNATURE
ROOM NO. EXT.

SECTION D (TO BE COMPLETED BY UNIVERSITY DATA DEPARTMENT)

DATE ACTIONED ON UNIT-E DATA STAMP
DATE COPY SENT TO FINANCE
DATE COPY SENT TO SCHOOL

VERSION 1 – UPDATED 16TH MAY 2017

H.E. STUDENT INITIATED DEFERRAL

DATE SLC NOTIFIED

VERSION 1 – UPDATED 16TH MAY 2017